Pediatrics Final Exam 2026/2027 | Pediatric Nursing Final Exam
Study Guide, Practice Questions with Answers & Rationales,
Growth and Development, Developmental Milestones,
Immunizations, Pediatric Assessment, Respiratory Disorders,
Cardiac Conditions, GI Disorders, Neurological Conditions,
Pediatric Medications, Safety & Family-Centered Care
Question 1: A 3-year-old child presents with fever, conjunctivitis, cracked lips,
and a polymorphous rash. Which of the following is the most likely diagnosis?
A. Scarlet fever
B. Kawasaki disease
C. Measles
D. Stevens-Johnson syndrome
CORRECT ANSWER: B. Kawasaki disease
Rationale: Kawasaki disease is a vasculitis of unknown etiology that typically
affects children under 5 years. The classic diagnostic criteria include fever lasting
at least 5 days, conjunctivitis, oral mucous membrane changes (cracked lips,
strawberry tongue), polymorphous rash, extremity changes, and cervical
lymphadenopathy. Scarlet fever presents with a sandpaper-like rash and
strawberry tongue but lacks conjunctivitis. Measles features Koplik spots and a
cephalocaudal rash. Stevens-Johnson syndrome involves severe mucosal
blistering and is often drug-induced.
Question 2: A 6-month-old infant is brought for a well-child visit. The mother
reports the infant can sit with support, reaches for objects, and babbles. Which
developmental milestone is most appropriate for this age?
A. Rolling over from back to stomach
B. Sitting without support
C. Walking independently
D. Speaking two-word phrases
CORRECT ANSWER: A. Rolling over from back to stomach
Rationale: At 6 months, infants typically roll over in both directions, sit with
support, and begin to babble. Sitting without support is usually achieved by 8
months. Walking independently occurs around 12–15 months. Speaking two-word
,phrases is expected around 18–24 months. The ability to roll over is a key 6-
month milestone.
Question 3: A 2-week-old neonate presents with projectile non-bilious vomiting
after feeding. An olive-shaped mass is palpated in the right upper quadrant.
What is the most likely diagnosis?
A. Gastroesophageal reflux
B. Pyloric stenosis
C. Duodenal atresia
D. Malrotation with volvulus
CORRECT ANSWER: B. Pyloric stenosis
Rationale: Hypertrophic pyloric stenosis typically presents at 2–6 weeks of age
with projectile, non-bilious vomiting and a palpable olive-shaped mass in the right
upper quadrant. Gastroesophageal reflux is usually non-projectile and resolves
with positioning. Duodenal atresia presents with bilious vomiting and a double-
bubble sign on X-ray. Malrotation with volvulus presents with bilious vomiting and
acute abdominal pain.
Question 4: A 4-year-old child presents with a barking cough, inspiratory stridor,
and hoarseness following a recent upper respiratory infection. What is the most
likely diagnosis?
A. Epiglottitis
B. Croup
C. Bronchiolitis
D. Asthma
CORRECT ANSWER: B. Croup
Rationale: Croup (laryngotracheobronchitis) is characterized by a barking cough,
inspiratory stridor, and hoarseness, often following a viral URI. Epiglottitis
presents with high fever, drooling, and tripod positioning without a barking
cough. Bronchiolitis affects infants under 2 years with wheezing and respiratory
distress. Asthma presents with wheezing and reversible airflow obstruction.
,Question 5: A 10-year-old child is brought in with a sore throat, fever, and a
sandpaper-like rash. Examination reveals a strawberry tongue and palatal
petechiae. What is the most likely causative organism?
A. Staphylococcus aureus
B. Streptococcus pyogenes
C. Epstein-Barr virus
D. Corynebacterium diphtheriae
CORRECT ANSWER: B. Streptococcus pyogenes
Rationale: Scarlet fever is caused by group A beta-hemolytic Streptococcus
(Streptococcus pyogenes). It presents with sore throat, fever, sandpaper-like rash,
strawberry tongue, and palatal petechiae. Staphylococcus aureus can cause toxic
shock syndrome but not classic scarlet fever. Epstein-Barr virus causes infectious
mononucleosis with exudative pharyngitis and lymphadenopathy.
Corynebacterium diphtheriae causes a pseudomembrane and is rare in vaccinated
populations.
Question 6: A 5-year-old child presents with periorbital edema, dark urine, and
hypertension. Urinalysis shows hematuria and proteinuria. What is the most
likely diagnosis?
A. Nephrotic syndrome
B. Acute post-streptococcal glomerulonephritis
C. Urinary tract infection
D. Henoch-Schönlein purpura
CORRECT ANSWER: B. Acute post-streptococcal glomerulonephritis
Rationale: Acute post-streptococcal glomerulonephritis typically presents 1–2
weeks after a streptococcal infection with periorbital edema, dark urine
(hematuria), hypertension, and proteinuria. Nephrotic syndrome presents with
heavy proteinuria, hypoalbuminemia, and generalized edema without
hypertension. Urinary tract infection presents with dysuria, fever, and pyuria.
Henoch-Schönlein purpura involves palpable purpura, arthritis, and abdominal
pain.
, Question 7: A 6-year-old child with sickle cell disease presents with fever, cough,
and chest pain. Chest X-ray shows a new pulmonary infiltrate. What is the most
likely diagnosis?
A. Acute chest syndrome
B. Pneumonia
C. Pulmonary embolism
D. Asthma exacerbation
CORRECT ANSWER: A. Acute chest syndrome
Rationale: Acute chest syndrome is a leading cause of death in sickle cell disease,
characterized by fever, cough, chest pain, and a new pulmonary infiltrate on chest
X-ray. While pneumonia can present similarly, acute chest syndrome is the
specific diagnosis in this context. Pulmonary embolism is rare in children. Asthma
exacerbation does not typically cause a new infiltrate.
Question 8: A 3-day-old neonate presents with jaundice. Total serum bilirubin is
18 mg/dL. The infant is formula-fed and otherwise healthy. What is the most
appropriate next step in management?
A. Observation only
B. Phototherapy
C. Exchange transfusion
D. Start antibiotics
CORRECT ANSWER: B. Phototherapy
Rationale: Phototherapy is indicated for neonatal jaundice when bilirubin levels
exceed the threshold for the infant's age and risk factors. At 3 days of life, a
bilirubin of 18 mg/dL is above the threshold for phototherapy. Observation alone
risks kernicterus. Exchange transfusion is reserved for severe hyperbilirubinemia
unresponsive to phototherapy. Antibiotics are not indicated without signs of
infection.
Question 9: A 15-month-old child presents with fever, irritability, and refusal to
bear weight on the right leg. Examination reveals swelling and warmth over the
right tibia. What is the most likely diagnosis?
Study Guide, Practice Questions with Answers & Rationales,
Growth and Development, Developmental Milestones,
Immunizations, Pediatric Assessment, Respiratory Disorders,
Cardiac Conditions, GI Disorders, Neurological Conditions,
Pediatric Medications, Safety & Family-Centered Care
Question 1: A 3-year-old child presents with fever, conjunctivitis, cracked lips,
and a polymorphous rash. Which of the following is the most likely diagnosis?
A. Scarlet fever
B. Kawasaki disease
C. Measles
D. Stevens-Johnson syndrome
CORRECT ANSWER: B. Kawasaki disease
Rationale: Kawasaki disease is a vasculitis of unknown etiology that typically
affects children under 5 years. The classic diagnostic criteria include fever lasting
at least 5 days, conjunctivitis, oral mucous membrane changes (cracked lips,
strawberry tongue), polymorphous rash, extremity changes, and cervical
lymphadenopathy. Scarlet fever presents with a sandpaper-like rash and
strawberry tongue but lacks conjunctivitis. Measles features Koplik spots and a
cephalocaudal rash. Stevens-Johnson syndrome involves severe mucosal
blistering and is often drug-induced.
Question 2: A 6-month-old infant is brought for a well-child visit. The mother
reports the infant can sit with support, reaches for objects, and babbles. Which
developmental milestone is most appropriate for this age?
A. Rolling over from back to stomach
B. Sitting without support
C. Walking independently
D. Speaking two-word phrases
CORRECT ANSWER: A. Rolling over from back to stomach
Rationale: At 6 months, infants typically roll over in both directions, sit with
support, and begin to babble. Sitting without support is usually achieved by 8
months. Walking independently occurs around 12–15 months. Speaking two-word
,phrases is expected around 18–24 months. The ability to roll over is a key 6-
month milestone.
Question 3: A 2-week-old neonate presents with projectile non-bilious vomiting
after feeding. An olive-shaped mass is palpated in the right upper quadrant.
What is the most likely diagnosis?
A. Gastroesophageal reflux
B. Pyloric stenosis
C. Duodenal atresia
D. Malrotation with volvulus
CORRECT ANSWER: B. Pyloric stenosis
Rationale: Hypertrophic pyloric stenosis typically presents at 2–6 weeks of age
with projectile, non-bilious vomiting and a palpable olive-shaped mass in the right
upper quadrant. Gastroesophageal reflux is usually non-projectile and resolves
with positioning. Duodenal atresia presents with bilious vomiting and a double-
bubble sign on X-ray. Malrotation with volvulus presents with bilious vomiting and
acute abdominal pain.
Question 4: A 4-year-old child presents with a barking cough, inspiratory stridor,
and hoarseness following a recent upper respiratory infection. What is the most
likely diagnosis?
A. Epiglottitis
B. Croup
C. Bronchiolitis
D. Asthma
CORRECT ANSWER: B. Croup
Rationale: Croup (laryngotracheobronchitis) is characterized by a barking cough,
inspiratory stridor, and hoarseness, often following a viral URI. Epiglottitis
presents with high fever, drooling, and tripod positioning without a barking
cough. Bronchiolitis affects infants under 2 years with wheezing and respiratory
distress. Asthma presents with wheezing and reversible airflow obstruction.
,Question 5: A 10-year-old child is brought in with a sore throat, fever, and a
sandpaper-like rash. Examination reveals a strawberry tongue and palatal
petechiae. What is the most likely causative organism?
A. Staphylococcus aureus
B. Streptococcus pyogenes
C. Epstein-Barr virus
D. Corynebacterium diphtheriae
CORRECT ANSWER: B. Streptococcus pyogenes
Rationale: Scarlet fever is caused by group A beta-hemolytic Streptococcus
(Streptococcus pyogenes). It presents with sore throat, fever, sandpaper-like rash,
strawberry tongue, and palatal petechiae. Staphylococcus aureus can cause toxic
shock syndrome but not classic scarlet fever. Epstein-Barr virus causes infectious
mononucleosis with exudative pharyngitis and lymphadenopathy.
Corynebacterium diphtheriae causes a pseudomembrane and is rare in vaccinated
populations.
Question 6: A 5-year-old child presents with periorbital edema, dark urine, and
hypertension. Urinalysis shows hematuria and proteinuria. What is the most
likely diagnosis?
A. Nephrotic syndrome
B. Acute post-streptococcal glomerulonephritis
C. Urinary tract infection
D. Henoch-Schönlein purpura
CORRECT ANSWER: B. Acute post-streptococcal glomerulonephritis
Rationale: Acute post-streptococcal glomerulonephritis typically presents 1–2
weeks after a streptococcal infection with periorbital edema, dark urine
(hematuria), hypertension, and proteinuria. Nephrotic syndrome presents with
heavy proteinuria, hypoalbuminemia, and generalized edema without
hypertension. Urinary tract infection presents with dysuria, fever, and pyuria.
Henoch-Schönlein purpura involves palpable purpura, arthritis, and abdominal
pain.
, Question 7: A 6-year-old child with sickle cell disease presents with fever, cough,
and chest pain. Chest X-ray shows a new pulmonary infiltrate. What is the most
likely diagnosis?
A. Acute chest syndrome
B. Pneumonia
C. Pulmonary embolism
D. Asthma exacerbation
CORRECT ANSWER: A. Acute chest syndrome
Rationale: Acute chest syndrome is a leading cause of death in sickle cell disease,
characterized by fever, cough, chest pain, and a new pulmonary infiltrate on chest
X-ray. While pneumonia can present similarly, acute chest syndrome is the
specific diagnosis in this context. Pulmonary embolism is rare in children. Asthma
exacerbation does not typically cause a new infiltrate.
Question 8: A 3-day-old neonate presents with jaundice. Total serum bilirubin is
18 mg/dL. The infant is formula-fed and otherwise healthy. What is the most
appropriate next step in management?
A. Observation only
B. Phototherapy
C. Exchange transfusion
D. Start antibiotics
CORRECT ANSWER: B. Phototherapy
Rationale: Phototherapy is indicated for neonatal jaundice when bilirubin levels
exceed the threshold for the infant's age and risk factors. At 3 days of life, a
bilirubin of 18 mg/dL is above the threshold for phototherapy. Observation alone
risks kernicterus. Exchange transfusion is reserved for severe hyperbilirubinemia
unresponsive to phototherapy. Antibiotics are not indicated without signs of
infection.
Question 9: A 15-month-old child presents with fever, irritability, and refusal to
bear weight on the right leg. Examination reveals swelling and warmth over the
right tibia. What is the most likely diagnosis?
